Abstract
Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.
Highlights
Dengue fever (DF) is an acute febrile illness that follows a self-limiting course
Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage
The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies
Summary
Abstract: Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Outbreaks have increased in severity over the past few years, especially in developing countries in South Asia.[1,2] The World Health Organization (WHO) estimates that approximately 2.5 billion individuals are susceptible to DF and a 100 million are infected every year.[3] While DF is a self-limiting illness in the majority of patients, about 0.5% of patients develop a complicated course requiring specialised therapy.[3] A total of 20,000 deaths are reported annually worldwide due to complications associated with severe DF.[3] According to the WHO Eastern Mediterranean Regional Office, there have been 16,580 confirmed cases of DF and 257 deaths due to the disease in Pakistan alone since 2010.4 There have been several preventable. The patient eventually had a spontaneous recovery and normalisation of ejection fraction (EF) and cardiac parameters
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